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Controversial Treatments for Children With Attention-Deficit/Hyperactivity Disorder

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By Sam Goldstein, Ph.D.

Alternative Treatments: Another Path

There is also a second path which some practitioners follow, sometimes in an effort to shortcut the longer, more accepted process. This path, unfortunately, is fraught with many problems. On this path, proposed treatments stem from concepts which are outside of the mainstream of existing knowledge or just along its border. They may be instituted long before there is any research which supports their effectiveness - often after only brief, poorly designed trials involving a small number of subjects. Measurement techniques and means of evaluation are scanty at best and often single case studies are offered as proof of the effectiveness of a treatment. This treatment approach is usually publicized in books or journals which do not require independent review of the material by recognized experts in the field. Often, in fact, the advocate of a particular treatment publishes the work. This method of self- publication should raise a warning for consumer parents. Additionally, although parent support groups have an essential role the in treatment of childhood disorders, parent support groups advocating one and only one treatment for a disorder, unfortunately substitute enthusiasm for careful scientific research.

It is critical for parents to seek the best in evaluation, as well as the best in treatment. Evaluations that consist of a single checklist or ten-minute discussions, will likely run the risk of mis-diagnosis of the disorder or, in fact, a misunderstanding of co-occurring problems that often present for children with AD/HD. Symptoms of inattention, restlessness, impulsivity, and social and academic difficulties, can reflect a variety of childhood disorders. It is essential to obtain a thorough understanding of problems before attempting to intervene, especially since many children with AD/HD also experience co-existing learning and behavior problems. A good treatment plan follows logically from a thorough evaluation.

These alternative treatments and interventions commonly claim effectiveness for a broad range of problems. When asked for proof to support these claims, however, proponents are unable to produce more than scanty documentation. Proponents may also claim to have access to knowledge and information not shared by the medical community at large and when their treatments are criticized they may explain this as reflecting a conspiracy against them in a scientific community.

Controversial Treatments for AD/HD

Dietary Intervention

Among the best known dietary interventions, the Feingold Diet has advocated that children sensitive to a variety of foods and food colorings, including preservatives, may develop symptoms of AD/HD as a toxic reaction to these substances. Over the years advocates of these dietary interventions have made dramatic claims. They have stated that additive free diets will improve most if not all children's learning and attention problems. They describe case studies in which children could be removed from drug therapy if their diet was maintained. They also report improvements in school for these children and subsequent deterioration in learning and behavior when the diet is not followed.

Although dietary interventions are popular, few studies have reported success and for most of these, statistical problems abound. The lack of well controlled studies is also true for those who propose a relationship between allergies and behavior or learning problems. Although proponents of these dietary approaches may acknowledge that careful scientific studies are necessary, such studies have not yet been conducted.

A large number of studies, however, have examined the relationship between sugar and AD/HD. However, most of them are difficult to interpret. A few well-designed studies have found some effects of sugar on behavior but these effects are very small and only a small percentage of children with AD/HD appear vulnerable.

After careful analysis of the existing evidence, numerous researchers have concluded that there is limited, if any, support for a link between diet and children's learning and behavior. Of course, like all children, we know that children with AD/HD require a healthy, well-balanced diet. At this time, however, it has not been shown that dietary interventions offer significant help for children with learning and attention problems.

Sam Goldstein, Ph.D. is a Clinical Professor of Psychiatry at the University of Utah, a Research Professor of Psychology at George Mason University and Director of the Neurology, Learning and Behavior Center in Salt Lake City, Utah. He is Editor-in-Chief of the Journal of Attention Disorders, author, co-author or editor of 26 books and dozens of book chapters and peer reviewed research articles.

This article originally appeared on Dr. Sam Goldstein's website in 2000,, and is reprinted here with permission.

Comments from readers

"When did Goldstein write this? His information about the Feingold diet is inaccurate and out of date. For example,the double-blind Rowe & Rowe (1994) study found a dose-response effect for tartrazine (Yellow #5), and there is the 2007 McCann study that found that even normal children react to a modest amount of food dyes with increased activity and decreased attention span. There is the landmark 2006 Lau study in which he tested additives in combination and found that the combinations were many times more powerfully toxic to developing nerve tissue. Actually, every single study done since 1987 has shown clearly that the diet works - often dramatically. Some tested a more restrictive diet called an oligoantigenic (few foods) diet, but they got the same results. These studies have been replicated over and over with similar results. Most recent literature reviews agree that the diet is effective to treat ADHD. The 2004 Schab meta-analysis agrees as well. The American Academy of Pediatrics published an article in their 2008 Grand Rounds that admitted that after 30 years of saying the diet doesn’t work they “may have been wrong.� They now say, “. . . a trial of a preservative-free, food coloring–free diet is a reasonable intervention.� The British Medical Journal, in May 2008, said a “trial of eliminating colourings and preservatives should be part of standard treatment . . .� "
"Thank you so much for this artical on questionable ADD Treatments. I was wondering if you had another artical with Treaments that have proven success and how to get them? I am a desperate parent trying to help my son hear and understand me when I am talking to him. Thanks "